基线血浆基质金属蛋白酶-1含量与冠状动脉造影术患者全死因死亡率的相关性分析

Relation of baseline plasma MMP-1 level with all-cause mortality in patients undergoing coronary angiography

摘要:

目的  探讨基线血浆基质金属蛋白酶-1（MMP-1）水平对经冠状动脉造影术确诊或疑似冠状动脉粥样硬化性心脏病（以下简称冠心病）男性患者的远期预后意义。方法  检测364例接受冠状动脉造影术男性患者的基线血浆MMP-1水平，随访术后5年患者的全因死亡，并分析基线血浆MMP-1含量与患者5年期全因死亡率的相关性。结果  经多种基线临床指标、血管造影指标和生化指标校正后，基线血浆MMP-1水平是冠状动脉造影术患者5年期全因死亡率的独立预测因素[HR=1.49（95%CI：1.23，1.80）P =0.000]。另外3个多变量模型包含一系列具有明确预后意义的生物标志物，如人基质裂解素-2（ST2）、生长分化因子-15（GDF-15）、胱抑素C、高敏C反应蛋白（hs-CRP）、髓过氧化物酶、基质金属蛋白酶抑制剂-1（TIMP-1）、脂联素、红细胞分布宽度（RDW）、红蛋白和促红细胞生成素，研究证实MMP-1仍然是5年期全因死亡率的独立预测因素。仅对180例急性冠状动脉综合征患者进行分析，也得到类似结果。结论  基线MMP-1含量升高与经冠状动脉造影术确诊或疑似冠心病患者长期全因死亡率风险增加相关。

Abstract:

Objectives To investigate the long-term prognostic significance of baseline plasma MMP-1 level in a group of well-characterized male patients with known or suspected coronary artery disease, including those presenting with the acute coronary syndrome. Methods Baseline plasma MMP-1 level was measured in 364 male patients who received coronary angiography and were followed up prospectively for 5 years for the development of all-cause mortality. Results After adjustment for a variety of baseline clinical, angiographic and laboratory parameters, baseline plasma MMP-1 level (analyzed as a continuous variable) was an independent predictor of all-cause mortality in 5 years [HR = 1.49, (95%CI: 1.23, 1.80), P = 0.000]. Furthermore, in 3 additional multivariate models that included a wide variety of contemporary biomarkers with established prognostic significance (i.e., Stromelysin-2, GDF-15, cystatin C, hs-CRP, myeloperoxidase, TIMP-1, adiponectin, red blood cell volume distribution width, hemoglobin, and erythropoietin), MMP-1 remained an independent predictor of all-cause mortality in 5 years. Similar results were obtained when the analyses were restricted to the subpopulation of patients presenting with acute coronary syndrome. Conclusions Elevated level of MMP-1 is associated with an increased risk of long-term all-cause mortality in patients with known or suspected coronary disease that is independent of a variety of clinical, angiographic, laboratory variables, including a whole host of contemporary biomarkers with established prognostic significance representing multiple different pathophysiologic processes.